Restoring consumer confidence in air travel — Real-time PCR testing

This article is part of a series of essays that present my personal point of view (with related references) critiquing and discussing the wide spread notions pertaining to restoring consumer confidence and trust in air travel, in light of the coronavirus (Covid-19) pandemic that has impacted on air travel demand.

Adiel Mambara
Aviation expert

The first article in this series will explore at a top level, the idea of Real Time (RT) Polymerase Chain Reaction (PCR) Covid-19 testing at airports as a way of restoring consumer confidence.

The global real-time polymerase chain reaction (PCR) testing market is expected to grow from US$7,5 billion in 2019 to about $22.4 billion in 2020 as there is a surge in the number of tests being conducted for the diagnosis of Covid-19.

Early detection plays a key role in treating Covid-19 patients. The real time RT-PCR technique is a highly sensitive and specific testing method that can deliver a reliable diagnosis in as fast as three hours, unlike the other laboratory tests that take an average of six to eight hours.

Real time RT-PCR is significantly faster and has a lower potential for contamination or errors as the entire process is within a closed tube. Therefore, currently it is considered to be the most accurate method available for detection of the coronavirus.

RT PCR Covid-19 tests are able to determine the presence of Covid-19 virus on swabs taken from your throat and nose. In broad biological terms, testing is characterised by viral and antibody testing.

Viral testing tells if a person has the Covid-19 infection and antibody testing tells if a person has had a past infection. An anti-body test might not show if you have a current infection, because it can take 1-3 weeks after infection for your body to make anti-bodies. However, more research on this topic outside the scope of this article needs to be undertaken, before the association between viral and antibody system is more clearly understood.

In light of the enhanced knowledge of Covid-19, the responsible restart of travel and tourism is now underway around the world with 40% of destinations easing travel restrictions, amid a pandemic that has resulted in over £245 billion (US$319,9 billion) in lost revenues according to the World Tourism Organisation (WTO). Airports Council International (ACI) predicts that Covid-19 will wipe out two-fifths of passenger traffic and almost half of revenues for airports in 2020.

There has been easing of border restrictions in some countries in Europe resulting in the creation of a few travel corridors between several countries.
With a continued worsening traffic outlook for airlines, one crucial epidemic control measure that must be advanced globally for the safe restart of the air transport sector is RT PCR Covid-19 testing of every passenger who departs and arrives at any airport globally.

Responses to the ongoing Covid-19 pandemic have included travel bans and social distancing with “shelter in place” orders, resulting in sudden changes in human activity and subsequent effects on the global and national economy.

However for specific industries such as aviation, measures like social distancing simply do not work onboard an aircraft, and as such there are growing public calls around the world for governments to start integrating testing at airports as a first option, in substitution of the 14 days self-isolation.

Several airlines have called on governments to work on establishing a joint Covid-19 testing programme to allow travel to resume between Europe and the US, which is still largely restricted.

There is general public consensus around the world that restrictions on people’s movements especially on travel to high –incidence areas, is a sensible measure, however government decisions on the implementation of policy must be well balanced and based on solid factual evidence. Measures must be guided by science and collaboration and not by politics.

Recently the United Kingdom (UK) government singled out Spain by removing the country off the Travel Corridor list, due to the recent increase in reported cases; 8 207 in one week vs 5 292 in the previous week. The UK did not take into account that these cases were mostly due to localised spikes in the North-Eastern part of Spain (particularly Catalonia) and mainly involved positive PCR’s of asymptomatic people.

Against this background, there is an argument that no government can ignore the re-imposition of quarantine requirements on people coming from countries that have high transmission rates.

However governments still need to avoid knee jerk reactions and give proper guidance within a reasonable time frame and that is why RT PCR Covid-19 testing is a valid measure to support and advance.

Ideally Covid-19 testing should be conducted in advance of arrival to the airport and with-in 72 hours of travel. This will enable re-accommodation of passengers who are found to be positive.

There are several important factors that have a major impact on testing that are critical to understand if we are able to achieve better outcomes to testing. These factors include accuracy, costs and capacity that are explained below.

It is important to understand the limitations on testing. No diagnostic test is 100% accurate and this is particularly true when the prevalence of the disease is low.

According to the WHO, the incubation period for Covid-19 is generally 2-7 days (up to 12) and tests are likely to detect the virus in 2-3 days prior to the symptoms developing and 2-3 days after. A negative test only tells us about the passenger’s status at that point in time. There is a potential that an individual could well be incubating an infection that was not able to be detected yet and that is why it is important for the tests to be conducted at both departure and arrival at airports within a reasonable timeframe. This is an important issue for future research and there is abundant room for further progress in determining more accurate tests in the future.

Further research should be undertaken to investigate how well tests are carried out, and who is qualified to take the tests, once the swab tests have been taken, how do we eliminate the chances of the swab tests not reaching the infected area, consider introducing a system of double testing (one test conducted at the airport and another test at a designated Covid-19 facility) a week apart to have a better chance of identifying who has been affected.

Cost is an important consideration for passengers, and testing should facilitate travel and not act as an economic barrier.

The cost of a standard test can be between 59 euros (US$69) to 200 euros (US$235) in some western countries. This can be quite expensive for groups/families travelling together especially for the leisure market.

Given the importance of air transport and its contribution to world economies, I personally feel that, this is a cost that governments can subsidise or cover in full.

The challenge of testing at airports depends very much on the testing capacity. No one can ignore the fact that testing capacity of any airport can stretch the operational manner in which an airport functions and not to mention the practical difficulties of setting up testing facilities at busy airports.

Iceland for example started testing on arrival on the June 15, 2020 and limited the testing capacity to 500 a day (equivalent to around two Boeing 787 aircraft with passengers). Capacity has now increased to 2000 a day.

In most cases the current testing capacity still only represents less than a third of people who travel through most airports in the world. A useful suggestion would be for governments to set up pilot schemes in high risk countries, to evaluate the testing capacity across low and high demand periods. This will enable governments to assess, the equipment needed, adapting the facilities accordingly and training additional staff, all of which will require time.

The International Civil Aviation Organisation (ICAO) recommends a phased approach to enable the safe return to high volume air travel for passengers and cargo.
Their approach includes a core set of measures of health protocols that protect air passengers and aviation workers from Covid-19. There are several countries that have started advancing this concept of testing in line with ICAO‘s recommended approach and these include:

In Cambodia, all foreign passengers must pay a US$3 000 deposit for mandatory Covid-19 testing and possible treatments.

In Germany (Frankfurt Airport Test Centre), offers testing at the airport starting from 59 euros (results take between six to eight hours); to get an express test costs 139 euros (US$163) results are out in three hours). Germany is also establishing Covid-19 test centres at all major airports in the country.
In Hong Kong, all passengers are now tested on arrival and the process can take up to 8 hours.

In Iceland, all passengers are now tested on arrival and the cost (US$63) is borne by the passenger.

In Moscow Domodedovo Airport, one of the largest air hubs in Russia, has set up a Covid-19 virus testing service. Airline passengers can now take the test at the airport’s medical care facility.

Tanzania, passengers must present a valid Covid-19 certificate from an approved laboratory conducted within 72 hours of travel. A completed health surveillance form is also required for entry into the country.

As Covid-19 restrictions are gradually lifted, some of the issues emerging are that of a second wave of Covid-19 across a number of countries, with the World Health Organisation (WHO) warning of the need for “extreme vigilance” in countries that are now emerging from lockdown.

A vaccine remains the best possible option to guard against the virus. But with a vaccine still months or even years away, the aviation industry will have to rely on other epidemic control measures in the short to medium term.

The green shoots of recovery for the aviation industry will only emerge when measures such as RT PCR Covid-19 testing are implemented as a matter of urgency across every airport globally.

We can all be confident that the aviation industry is extremely resilient, and governments across the world need to start listening to the aviation industry and the medical experts in coming up with a global solution if any meaningful progress is to be made in an industry that provides tens of millions of jobs.
Testing is certainly the step in the right direction!

Zimbabwe-born Mambara, who has a demonstrated history of working in the airlines/aviation industry, is currently the country manager (UK and Ireland) for Royal Brunei Airlines.